| Thayer Hussein Dds,inc | |
|
13872 Harbor Blvd Ste 1a-3 Garden Grove CA 92843-4041 | |
| (714) 265-1000 | |
| (714) 265-1000 |
| Full Name | Thayer Hussein Dds,inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13872 Harbor Blvd Ste 1a-3, Garden Grove, California |
| Authorized Official Name and Position | Thayer Hussein (OWNER) |
| Authorized Official Contact | 7145886500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thayer Hussein Dds,inc 10591 Ramblewood Dr Stanton CA 90680-2149 Ph: (714) 588-6500 | Thayer Hussein Dds,inc 13872 Harbor Blvd Ste 1a-3 Garden Grove CA 92843-4041 Ph: (714) 265-1000 |
| NPI Number | 1679081848 |
|---|---|
| Provider Enumeration Date | 01/22/2018 |
| Last Update Date | 02/08/2018 |
| Medicare PECOS PAC ID | 6103155668 |
|---|---|
| Medicare Enrollment ID | O20190909001546 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679081848 | NPI | - | NPPES |
| 1881030872 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 64043 (California) | Primary |
| Provider Name | Thayer F Hussein |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1881030872 PECOS PAC ID: 7911236476 Enrollment ID: I20190909001874 |
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